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Objective To evaluate the peri-operative and survival outcomes of hepatectomy combined with splenectomy in patients with hepatocellular carcinoma with Barcelona Clinic Liver Cancer Stage A and portal hypertension.Methods We retrospectively analyzed the data on patients with hepatocellular carcinoma with Barcelona Clinic Liver Cancer Stage A and portal hypertension who underwent surgery at the Shengli Oilfield Central Hospital between July 2008 and June 2015.According to the operative method,the patients were classified as the experimental group (hepatectomy combined with splenectomy) and the control group (hepatectomy).We compared and analyzed the clinical data between these two groups,which included the operation time,blood loss,duration of hepatic portal occlusion,width of surgical resection margin,liver function,PLT,HBV reactivation,time to remove drainage tube,complications,upper gastrointestinal hemorrhage rate and survival outcomes.Results (1) The operation time,blood loss,PLT at 1 week and 1 month after surgery in the experimental group were all significantly higher than the control group [(161.4 ± 38.3) min vs.(119.2±36.4) min,(268.7±72.1) vs.(201.3±61.3) ml,(189.2±51.3) ×109/L vs.(81.9±32.2) ×109/L,(327.4±69.1) ×109/L vs.(84.5±28.5) × 109/L (all P＜0.05),respectively].The time to remove drainage tube,duration of hepatic portal occlusion,width of resection surgical margin,TBil,complications and upper gastrointestinal hemorrhage rates of the two groups were not significantly different (all P ＞ 0.05).The HBV reactivation rate,ALT and AST in the experimental group were significantly lower than the control group [3.9％ (2/51) vs.18.2％ (12/66),(45.7 ± 11.4) U/L vs.(58.3±14.7) U/L,(48.1±12.4) U/Lvs.(61.3±15.1) U/L (allP＜0.05),respectively].(2) The 1,3 and 5-year recurrence free survival rates were not significantly different between the experimental and control groups [84.3 ％,34.1％,27.3 ％ vs.78.8 ％,42.1％,9.7 ％ (all P ＞ 0.05),respectively].The 1,3 and 5-year overall survival rates in the experimental Group were significantly higher than the control group [94.1％,66.3 ％,33.5 ％ vs.90.9％,46.7％,16.1％ (all P ＜ 0.05),respectively].Conclusion Combined liver and spleen resection was a safe and efficacious modality to treat patients with BCLC A hepatocellular carcinoma,which reduced the incidence of HBV reactivation and improved the overall survival.
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Objective To investigate the impact of hepatectomy combined with splenectomy on hepatitis B virus (HBV) reactivation in patients with hepatocellular carcinoma (HCC) ≤5 cm and with hypersplenism.Methods This is a retrospective case-control study on 167 patients with HCC ≤5 cm and with hypersplenism who underwent hepatectomy combined with splenectomy at the Shengli Oilfield Central Hospital between May 2008 and June 2015.64 patients underwent hepatectomy combined with splenectomy,and 103 patients hepatectomy alone.The patients were assigned to the hepatectomy combined with splenectomy group (the combined group,n =61) or the hepatectomy alone group (the control group,n =61) using propensity score matching (PSM).Logistic regression was used to evaluate the relative clinical factors associated with HBV reactivation.The stratified Chi-squared test was utilized to determine the impact of the surgical procedure and preoperative anti-viral therapy on postoperative hepatitis B virus reactivation of these patients.Results The serum PLT level,Child-Pugh grading,tumor diameter and surgical procedures were shown to be independent risk factors associated with postoperative HBV reactivation (P ＜ 0.05).To study the impact of preoperative anti-viral therapy on postoperative HBV reactivation:-the incidence of HBV reactivation was higher in the control group than in the combined group (19.7％ vs.6.6％,P ＜ 0.05).In the combined group,there was no significant difference between patients who received anti-viral therapy and those who were treatment-naive (5.3％ vs.7.1％,P ＞0.05).In the control group,a higher incidence of HBV reactivation was found in patients with treatment-na(i)ve than in patients who received anti-viral therapy (26.1 ％ vs.0,P ＜ 0.05).For the patients who received anti-viral therapy,there was no significant difference between the combined group and the control group (5.3％ vs.0,P ＞ 0.05).In patients with treatment-na(i)ve,a higher incidence of HBV reactivation was observed in the control group than the combined group (26.1％ vs.7.1％,P ＜ 0.05).Conclusions In patients who were not treated with antiviral therapy,hepatectomy combined with splenectomy decreased the incidence of postoperative HBV reactivation in patient with HCC ≤5 cm and with hypersplenism.For the patients who received preoperative anti-viral therapy,the incidence of postoperative HBV reactivation was not decreased with hepatectomy combined with splenectomy.
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Objective To evaluate the impact of obesity and spleen length on laparoscopic splenectomy combined with pericardial devascularization.Methods We retrospectively analyzed 121 patients with portal hypertension who underwent laparoscopic splenectomy combined with pericardial devascularization in our hospital.Using BMI,these patients were classified as the obesity and the non-obesity groups.Using length of the spleen,the patients were divided into two subgroups:spleen AC diameter ＞ 20 cm and spleen AC diameter ≤20 cm.Results (1) For the Obesity group,the operation time,the rate of conversion to open operation and the complication rate after operation were higher than the non-obesity group [(184.0 ± 49.0) min vs (142.0 ±39.0) min,26.1％ vs 8.0％,26.1％ vs 6.7％,respectively,P＜0.05].However,the differences were not significant for mean blood loss,intraperitoneal drainage and complication rate after operation.For patients with massive splenomegaly,the obesity group had higher rates of conversion into open operation and complication (42.9％ vs 11.7％,33.3％ vs 8.8％,respectively,P ＜0.05).For patients with non-massive splenomegaly,the differences were not significant between the obesity and non-obesity groups (P ＞ 0.05).(2) For obesity patients,the spleen AC diameter ＞ 20 cm group had a longer operation time and a higher rate of conversion to open operation [(224.0 ± 42.0) min vs (152.0 ± 44.0) min,42.9％ vs 12.0％,respectively,P ＜ 0.05].The length of spleen had no effect on the operation and its complication (P ＞ 0.05).Conclusions Obesity extended the operation time and increased the rates of conversion to open operation and complication after operation.The spleen length had a major impact on the rates of conversion to open operation and complication after operation for the groups of obesity patients.
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Objective To study hcpatitis B virus (HBV) reactivation and related risk factors for ≤5 cm hepatocellular carcinoma (HCC) by radiofrequency ablation (RFA) or hepatic resection.Methods From Sep 2006 to Jan 2013,193 patients received hepatectomy and 146 patients received RFA.Univariate and multivariate logistic regression analysis was used to assess risk factors.Stratified x2 test for HBV reactivation,Unpaired student's t-test for CD4 +,CD8 +,CD4+/CD8+ and NK cell proportions.Results (1) Antiviral therapy,Child-Pugh grade,vascular invasion and treatment modality were significant risk factors of HBV reactivation (P ＜ 0.05).(2) HBV reactivation was lower in patients receiving antiviral therapy than those who did not (16/181 vs.25/158,x2 =3.869,P =0.049),the reactivation in hepatectomy group was higher than RFA group in those not using antiviral therapy (20/92 vs.5/66,x2 =5.788,P =0.016),but the difference was not significant in the antiviral therapy patients (10/101 vs.6/80,x2 =0.319,P =0.572).(3)CD3+,CD4+,CD4+/CD8+ and NK cell proportions after 7 days treatment decreased in different degree for both hepatic resection and RFA group with or without antiviral therapy (P ＜0.05).For patients who did not received antiviral therapy,the proportions of RFA after 7 days treatment were higher than the hepatic resection group (P ＜ 0.05).Conclusions Compared with ≤5 cm carcinoma treated by RFA,hepatic resection decreased the proportions of immune cells,preoperative antiviral therapy relieves immune suppression,decreases the incidence of HBV reactivation.
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Histiocytic sarcoma is a rare kind of histiocytic lymphoma with an undetectable onset, no specific clinical and imaging mani-festations, and rapid progression. At diagnosis, the histiocytic sarcoma has already spread significantly in most patients. The diagnosis of histiocytic sarcoma depends on the basis of its mitotic figures and at least expression of one of the following:CD68, CD163, and lyso-zyme. Operation excision, radiotherapy, and chemotherapy are currently the more common treatment methods for histiocytic sarco-ma. However, no unified curative and treatment standard exists, and prognosis is poor. This review summarizes the diagnosis and treat-ment of histiocytic sarcoma.
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Objective To investigate the value of liver resection and radiofrequency ablation (RFA) on reactivation rates of hepatitis B virus (HBV) in hepatocellular cancer (HCC) patients with tumor ≤5 cm and determine influential factors.Methods Retrospective analysis was performed in clinical data of hepatocellular cancer patients with tumor ≤5 cm from Shengli Oilfield Centeral Hospital between July 2007 and March 2012,289 cases were assigned to liver resection group (n =157) and RFA group (n =132).Logistic regression was used to evaluate relative factors associated with HBV reactivation for univariate and multivariate analyses.The stratified x2 test was utilized to assess clinical outcomes in HBV reactivation subgroup with or without antiviral treatment.CD3 +,CD4+,CD8 +,CD4+/CD8 + and NK cell proportions were comparatively analysized.Results (1) The univariate and multivariate logistic regression analyses showed antiviral therapy,Child-Pugh grade,vascular invasion and treatment (liver resection or RFA) were significant risk factors of HBV reactivation (P ＜ 0.05).(2) HBV reactivation was lower in patients who received antiviral therapy than those who did not (10/109 vs 33/180,x2 =4.497,P ＜ 0.05).The viral reactivation rate for the liver resection group was higher than the RFA group in patients who did not receive antiviral therapy (24/98 vs 9/82,x2 =5.446,P ＜ 0.05),but the difference was not significant in patients who received antiviral therapy (6/59 vs 4/50,x2 =0.153,P ＞ 0.05).(3) The proportions of CD3 +,CD4 +,CD4 +/CD8 + and NK cell after treatment for 7 days decreased in various degrees for both the liver resection and RFA groups regardless of patients with or without antiviral therapy (P ＜ O.05).For the patients without antiviral therapy,the cell proportions in 7 days after treatment were significantly higher in the RFA group than that in the liver resection group (P ＜ 0.05),but the difference was not significant in patients with antiviral therapy (P ＞ 0.05).Conclusions For the patients with tumor ≤5 cm,the proportions of immunological cells decreased in liver resection when compared with RFA.Preoperative antiviral therapy may have partial response in immunological suppression,and lowered the incidence of HBV reactivation.
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Objective To evaluate effects of autologous cytokine-induced killer cell (CIK) transfusion on the survival and hepatitics B virus (HBV) reactivation after radiofrequency ablation (RFA) combined with transcatheter arterial chemoembolization (TACE).Methods A retrospective analysis was conducted on 185 patients with hepatocellular carcinoma treated from Mar 2007 to Oct 2013.Patients were divided into study group (RFA,TACE,CIK) of 98 cases and control group (RFA,TACE) of 87 cases.According to tumor size,numbers and vascular invasion,patients were stratified into 4 subgroups:the high and the low risk group respectively with tumor ≤ 5 cm and ＞ 5 cm.Results The 1-,3-,5-year survival rate between study and control group were not significantly different:75.5％ (74/98),57.1％ (56/98),20.4％ (20/98) vs.71.2％ (62/87),54.0％ (47/87),21.8％ (19/87) (P ＞ 0.05).Only the study group's 1-,3-,5-year survival rate of high risk patients with tumor ≤ 5 cm were higher than the control group:75.0％ (21/28),53.6％ (15/28),35.7 ％ (10/28) vs.61.9％ (13/21),42.9％ (9/21),23.5％ (5/21) (P ＜ 0.05).The incidence of HBV reactivation was lower in dunantiviral patients who received CIK therapy than those who had 6.0％ (3/50) vs.23.5％ (12/61) (P ＜ 0.05).Conclusion Postoperative adjuvant CIK therapy with tumor≤5cm after RFA combined with TACE was beneficial to the survival of high risk patients and decreased the risk of HBV reactivation.